Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

January 2019

HPI to Administer BMC HealthNet Plan


Effective Jan. 1, 2019, the BMC HealthNet employee benefit plan will be administered by Health Plans, Inc. (HPI), a Harvard Pilgrim company. Please be aware of the following regarding this change.

Recognizing members

BMC HealthNet employees are aware of the change and have been issued new ID cards (see sample below), which display the BMC Select and HMO plan names and Health Plans logo prominently.

Checking benefits & eligibility

Visit www.healthplansinc.com/providers to check benefits and eligibility. Simply click on “Check Eligibility” and follow the onscreen prompts.

PCPs and referrals

BMC HealthNet members on HPI’s Select and HMO plans must have a PCP to coordinate care. In addition, referrals are necessary for members of Select and HMO plans for certain services. Please keep in mind that if the PCP is making the referral within his or her established referral circle with Harvard Pilgrim (usually among specialists in the PCP’s care unit), a referral transaction is not required. However, if a PCP is referring the HMO member outside of his or her referral affiliation, a referral transaction is necessary.

In addition, the following services do not require a referral: family planning services; outpatient maternity services; gynecological services; acupuncture; chiropractic care; routine vision exams; emergency services; and urgent care services with participating providers. Services requiring authorization also don’t require a referral.

To submit a referral in 2019, visit the Referral Portal. If you haven’t already registered to submit referrals to HPI, you’ll need to register online by completing the Referral Portal Access Form.

Or, if you prefer to submit referrals on paper, you can find these in the Access Forms section of the HPI website.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

HPHConnect for Providers Getting a New Look in 2019

2019 Quality Grant Applications Due by Feb. 15

HEDIS 2019 Coming Soon: Your Cooperation is Crucial

HPI to Administer BMC HealthNet Plan

Behavioral Health: Services for Improved Access

CLINICIAN CORNER

New Opioid Safety Edits for 2019 Medicare Advantage Plans

Medical Policy Update: Tumor Treating Fields

Reminder: Formulas and Enteral Nutrition Require Prior Authorization

Updates to Proton Beam Therapy Medical Policy

Lumoxiti Now Covered with Prior Authorization

TriVisc and Jivi Now Covered with Prior Authorization

Pharmacy and Therapeutics Committee Meeting Update

OFFICE ASSISTANT

Coding Program Launching in January for Medicare Advantage

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator